My crew mate was driving, so we'd be there is 7 minutes, at times I start the paper work on the way just so I don't need to look at the road and traffic ahead. I digress.
As we made our way through the morning rush hour traffic with full blue lights, sirens and bull horns going, the red brake lights of traffic parting, as if commanded by Moses at the shores of the Red Sea, we picked our way through the traffic.
Within 3 minutes the MDT gave us more information, we were racing towards a rural cottage, to a patient, 59 years of age with crushing central chest pain radiating down the left arm. The next message made my crew mate push his already lead foot hard to the metal. "patient sounds desperate."
These were classic signs of a heart attack, with a danger of cardiac arrest. My crew mate and I talked through our action plan, preparing for the worse, hoping for the best.
Chest pain isn't always cardiac related, in fact, more often than not, the symptom is from some other cause. An oesophageal spasm for example, a twisting of the tube that leads from the throat to the stomach can cause similar symptoms to cardiac pain.
It was a long 8 minutes to the address, with up dates coming through thick and fast, telling us the patient was getting worse and increasingly panicked.
Finally we got to the scene, without switching off the engine or lights, my crew mate and I grabed the drugs bag, the ECG* machine, response bag and defibrillator.
As we walked through the door of the cottage, we gave the usual greeting "Hello, the ambulance service" What we got back in response was strangulated with pain, "in here." A quick look in a couple of rooms , we found our quarry, a youngish looking patient, their face contorted with pain, dysponea (difficulty in breathing) was obvious. although the cardiogenic grey pallor that gave the game away.
Without touching the distressed patient or further examination, the first glimpse of them told us this was serious. Quickly and calmly my crew mate did basic obs, blood pressure, blood oxygen saturation, heart rate, while I attached the the ECG machine to take a reading. Already 99% sure this was a cardiac event, the ECG would confirm what we and the patient already suspected.
Three minutes after our arrival, it was confirmed, our distressed patient was having, in layman's terms "a massive heart attack." Or as we call it, a anterior and inferior MI, known in the ambulance service as a barn door MI. It used to be known as a tomb stone MI but this was viewed as being less than appropriate. (The description refers to the shape the electrical activity of the heart makes on the ECG rhythm print out.)
On the example above you can see the rounded arch in most lines or leads that look like a barn doors or tomb stones.
Even as the rhythm strip came out of the ECG machine, I knew we had to get a move on. The patient was seriously ill.
With in seconds, I'd transmitted the ECG to the cardiac unit at hospital via 3G and was on the phone to them to see if they'd accept the patient. They did, we now had to get the patient out the ambulance and get on our way.
One of the golden rules about cardiac pain is to never walk the patient or put more pressure on the heart other than when absolutely necessary. With the patient chewing 300mg of aspirin to prevent further clotting, a quick check of their blood pressure and a quick squirt of GTN spray to open the blood vessels. My crew mate cannulated to get morphine access to relieve the pain. This calms the patient and calms the bodies physiological reaction to the pain. Which in turn makes the patient more comfortable.
We carried our kit and the patient out to the ambulance. A quick check of vital signs and obs, which remained ok, my crew mate jumped in the front and we left the scene.
Those of you who live in cities will find it hard to believe, but our running time to the receiving hospital was 45 minutes. It was going to be a long journey both for me and our patient.
One of the side effects of cardiac pain is vomiting, we gave a drug to try and stop the vomiting. About half way to hospital it became apparent the anti emetic drug hadn't done it's job. The poor patient, who was in considerable discomfort, scared they may die, started to vomit. How anyone could produce so much and at supersonic speed is beyond me. Hopelessly , I tried to catch the half digested porridge in several vomit bowls. Not easy in the back of an ambulance hurtling towards hospital sirens blaring and blue lights strobing. Unfortunately, most of the vomit hit the floor of the ambulance, adding further danger to me. I could easily slip on the vomit as the ambulance careered round an unexpected corner.
We finally arrived at the hospital, the ambulance interior, the patient and I covered in partially digested porridge. As my crew mate opened the back door, vomit poured over the ramp onto the ambulance bay. With our job almost done, unusually, we were met by the cardiac team as we dragged the stretcher containing our patient and the equipment still hooked up to them out of the ambulance, they must have been concerned about our patient. At a quick pace (almost a run) while giving a brief over view to the cardiac consultant we headed up five floors to the cath lab.
The breathless handover while running through the hospital, "This is (name), 59 years old, sudden and acute onset of crushing chest pain approximately an hour ago, pain score 9/10 on scene, now 4/10. GCS of 15 throughout. we've given 300mg aspirin, 10 of morphine, GTN and oxygen @ 15ltrs.
While we watched, two metal tubes called stents where placed in the patients anterior and inferior descending coronary arteries. A couple of days later, all being well, our patient will be able to return to normal life.
It was just one hour and 5 minutes from the initial 999 emergency call to the life saving treatment being delivered.
A good interesting job and a fantastic outcome for our patient.
*MDT is the computer screen that relays information about jobs and is where the information like destination and address.
*ECG, Electrocardiogram, reads the electrical activity in the heart.
Good to see you back on here and to know that you are enjoying the new job. Jen
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